In the previous article, I drew on Václav Havel's The Power of the Powerless to explore why so many of us have become numb to injustice. In this article, I turn once again to history to ask a different question: who must lead the change?
What do Ernesto "Che" Guevara, Rudolf Virchow, Norman Bethune, Muthulakshmi Reddy, and Binayak Sen have in common? Each was a physician who refused to believe that medicine ended at the bedside. They recognized that suffering is often rooted in injustice, and they dedicated their lives to confronting both.
Why doctors can lead the way
Physicians occupy a rare position in society. They are entrusted with intimate access to people's lives at moments of profound vulnerability while simultaneously commanding a level of public credibility that few professions enjoy.
Every day, they witness how decisions made in legislatures, ministries, and boardrooms manifest as illness in clinics and hospitals. They see poverty translated into malnutrition, polluted environments into chronic disease, contaminated medicines into the death of their patients, and exam paper leaks into self-harm. This direct encounter with the consequences of structural inequities and injustices gives physicians a perspective that extends well beyond prescription-driven healthcare.
Because their observations emerge from lived clinical experience, doctors often carry moral authority across political and social divides. Their testimony resonates in courtrooms, policymaking forums, the media, and public discourse. Few professions are as well-positioned to demonstrate that many illnesses are not simply biological events but the predictable outcomes of political, economic, and social choices made by those in power.
This understanding has deep historical roots.
For Rudolph Virchow, a German pathologist, medicine could never be separated from politics. Investigating a typhus epidemic in Upper Silesia in 1848, he concluded that the outbreak was driven not by biology alone but by poverty, poor housing, hunger, illiteracy, and political exclusion. Health, he argued, could not be improved through medical treatment alone. It required transforming the conditions in which people lived.
The same year, Virchow co-founded Medical Reform, a weekly journal through which he advanced two ideas that would define social medicine: that "medicine is a social science" and that "physicians are the natural attorneys of the poor." These were not merely philosophical statements. They were a call for doctors to recognise that disease is inseparable from inequality and that medical practice carries an obligation to challenge the structures that produce suffering.
Virchow acted on these convictions throughout his career. In 1861, he helped establish the German Progressive Party and entered the Prussian parliament, where he became a prominent critic of Otto von Bismarck's militaristic agenda. He repeatedly argued that governments should invest in sanitation, education, housing, and clean water rather than military expansion, viewing these not as social welfare programmes but as essential public health interventions.
In doing so, he redefined the physician's role. The doctor was not merely a diagnostician or technician but also a public intellectual, an advocate, and an agent of social transformation.
Ernesto "Che" Guevara's journey from physician to revolutionary was shaped by the realization that medicine alone could not address the suffering he witnessed across Latin America. As a young medical student, his travels through Argentina, Chile, Peru, Colombia, and other countries exposed him to the harsh realities of poverty, exploitation, leprosy, and preventable disease.
He came to believe that illness was inseparable from the political and economic systems that produced inequality. "The life of a single human being is worth a million times more than all the property of the richest man on earth," he later wrote, arguing that treating individual patients while ignoring the structures that condemned millions to ill health was ultimately inadequate.
This conviction drew him into the Cuban Revolution, where he served first as a battlefield physician and later as one of its principal leaders. Whether one agrees with his politics or not, Guevara's life represents one of the most striking examples of a doctor who concluded that healing society required transforming the social conditions that made people sick. His journey continues to provoke an enduring question for physicians: where does the responsibility to care end, and where does the responsibility to seek justice begin?
Empathy alone is not enough
In a recent Instagram post, Christianez, Nivarana's Lead Editor, reflected on why doctors and medical students have remained largely absent from protests in the country. While some doctors’ associations (like the Resident Doctors Associations of AIIMS Delhi and VMMC, Delhi, and the medical student association of MAMC, Delhi) have taken a stand this time during the CJP protest, most often doctors have contributed to protests mostly in an individual capacity. The only times when doctors have united to take a collective stand are during the Right to Health protests in Rajasthan and the protests following the RG Kar rape and murder incident.
This raises a broader and uncomfortable question: why have doctors, in the recent past, mobilized primarily when their own interests are threatened, while remaining largely silent in the face of injustices affecting the communities they serve—injustices that, directly or indirectly, are the root cause of all illnesses that the doctors work to treat?
Part of the answer lies in the way medicine is taught in India. Medical education has reduced health to diagnosis, prescriptions, and procedures. Social medicine survives largely as a few lectures drawn from Park's Textbook of Preventive and Social Medicine, with little effort to immerse students in the structural realities of poverty, discrimination, environmental degradation, and political decisions that shape the illnesses they encounter every day. Students are trained to treat the consequences of injustice without being encouraged to understand, question, or challenge its causes.
In recent years, the introduction of AETCOM (Attitude, Ethics and Communication) modules has sought to produce more empathetic doctors. While this is a welcome step, empathy alone is not enough, especially when the worry of recovering the cost spent on medical education bears heavily on many.
Empathy teaches us to feel another person's suffering. Compassion compels us to act upon it. A doctor who merely empathizes with a patient may experience grief, frustration, or helplessness, but a compassionate doctor asks why the suffering exists in the first place, what can be done to prevent it, and then takes action. Without this transition from empathy to action, doctors risk emotional exhaustion, which in turn impacts the level of empathy they feel.
They repeatedly witness preventable suffering yet are never equipped with the intellectual or practical tools to confront the social, economic, and political structures that produce it. As they internalize this culture of normalization, doctors learn that empathy is acceptable, but compassion that challenges injustice is risky. It becomes safer to feel for patients than to act on the causes of their suffering.
Equally troubling is the absence of role models who demonstrate that medicine extends beyond the walls of hospitals. Medical students are rarely encouraged to see physicians as advocates for justice or as leaders capable of shaping public policy. Instead, conformity is quietly rewarded.
A recent conversation with a medical student brought this into sharp focus. The student was deeply distressed after being asked by a senior to take a shortcut in patient care that conflicted with what they knew was ethically right. The dilemma was not simply about one clinical decision. It reflected the beginning of a much larger process of normalization, where students gradually learn that fitting into the system is often valued more than questioning it.
It is clear that the same normalization that has desensitized the broader public has also entered medicine. Doctors are not insulated from society; they are products of it. Those who refuse to accept questionable practices or challenge institutional failures are often dismissed as troublemakers, idealists, or "dissenters." From the very beginning of medical school, students who seek to understand the politics of health, question inequities, or look beyond multiple-choice examinations are frequently labelled "oversmart" or naive. They are advised to stop asking difficult questions, focus on clearing examinations, collect degrees, and leave the larger issues to someone else.
It is hardly surprising, then, that many doctors grow into competent clinicians but hesitant citizens. When conformity is rewarded throughout training, speaking truth to power becomes not a professional responsibility but a personal risk.
Beyond empathy to compassion
It is time for doctors in India to move beyond asking how to treat disease and begin asking why so much disease exists in the first place. Why are outpatient departments becoming increasingly crowded with patients who present only after their illnesses have reached advanced stages? Why do so many prescribed medicines remain financially out of reach for patients? Why do people have to die from contaminated medications?
Once the problems are realized, doctors need to transition from empathy to compassion. But does compassion always require great acts of sacrifice and courage?
In his TEDx Talk, Dr. Yogesh Jain describes three kinds of doctors who can bring about change. The first type of doctor provides the highest quality clinical care at the lowest possible cost to the patient. But this role extends beyond technical competence. It also requires the courage to protect patients' rights and dignity, even when political, institutional, or commercial pressures encourage unethical practices. Such a doctor ensures that every patient receives evidence-based treatment, helps them access social security schemes and welfare benefits they are entitled to, and acts as their advocate within a health system that is often confusing and unequal.
The second kind of doctor looks beyond the illness itself to understand why it occurred. Dr. Jain gives the example of a physician who notices several patients from the same village presenting with diarrhoea and investigates the community's water source rather than merely treating each individual case. This doctor recognizes that treating symptoms without addressing their cause simply guarantees that the next patient will soon arrive with the same illness.
The third kind of doctor works even further upstream, addressing the political, economic, and policy determinants that shape the health of entire populations. Rather than asking only how disease can be treated, this physician asks why disease is being produced in the first place and advocates for structural changes that prevent suffering before it reaches the clinic.
Today, social media has given every doctor, regardless of where they practise, the opportunity to become this third kind of physician. A doctor no longer needs to hold public office to influence public policy. By documenting injustice, amplifying marginalized voices, communicating evidence, and demanding accountability, physicians can shape public discourse and influence policy in ways that were unimaginable a generation ago.
Doctors possess not only scientific expertise but also a level of public trust that few professions command. Patients entrust them with their bodies, their stories, and often their lives. That trust carries an obligation that extends beyond the consultation room. It requires physicians to speak not only for individual patients but also for the communities whose suffering remains unheard.
Silence, therefore, is not neutrality. It is the choice to leave one's knowledge, credibility, and influence unused. In a society where those who suffer the most often have the least power to influence policy, doctors are uniquely positioned to transform clinical observations into public action and individual stories into demands for systemic reform.
Virchow reminded us that physicians are the "natural attorneys of the poor." More than a century and a half later, his words remain as relevant as ever.
India does not simply need more skilled doctors or even more empathetic doctors. It needs doctors with the courage to defend their patients, question unjust systems, and speak truth to power. The duty to heal does not end at the bedside. It extends to ensuring that the conditions making people sick are challenged, transformed, and never accepted as inevitable.
Edited by Radhikaa Sharma
Image by Gayatri
